Centralized Authorization Team
About The Position
A centralized authorization team oversees both patient referrals and authorization processes in a healthcare setting. Key responsibilities include obtaining pre-authorizations from insurance companies, managing referral documentation, and ensuring that patients are scheduled appropriately with specialists or for diagnostic services. They function as liaisons between healthcare providers, insurance companies, and patients to ensure smooth coordination of care. This role typically requires knowledge of medical terminology, insurance verification processes, and excellent communication skills, with experience in healthcare or customer service settings being highly beneficial.
Requirements
- This role typically requires 1-3 years of experience, preferably in a medical office or healthcare environment, and proficiency with electronic medical records (EMR) and scheduling systems. Strong organizational, communication, and customer service skills are essential, as the specialist often interacts with multiple stakeholders to facilitate patient care.
- High School Diploma or GED.
- Graduation from an accredited school of nursing or medical assistant school or program.
- Possession of a Florida RN, LPN license or an active MA certification or registration.
- Current American Heart Association recognized Basic Life Support (BLS) certification.
- At least one year of experience in outpatient nursing.
Responsibilities
- Review and process referral requests from physicians or healthcare providers.
- Ensure all necessary patient information and documentation are included.
- Obtain pre-authorizations and verify insurance coverage.
- Communicate with healthcare providers, insurance companies, and patients.
- Monitor and track the status of authorization requests, ensuring timely approvals.
- Maintain up-to-date and organized records for future reference and auditing.
- Accurately document all referral and authorization activity in patient records.
- Provide guidance and information to patients regarding their referrals and authorization processes.
- Responds to and refers to incoming telephone calls. Communicate referral details to patients, including instructions and expectations.
- Provide patient education and support throughout the referral process.
- Stays current with insurance requirements for referrals, authorizations, imaging, procedures etc.
- Ensure that services requiring authorization are covered under the patient’s insurance plan.
- Stay informed about changes in insurance policies and coverage guidelines.
- Acts as liaison between hospitals, physicians, patients, and other referral sources.
- Help train and assist other Referral Specialists.
- Troubleshoot and resolve issues related to referral and authorization denials.
- Follow up on any delays or discrepancies to expedite services for patients.
- Consistently displays a positive attitude and a personal commitment to excellence.
- Attends all department meetings and clinic required meetings.
- Ensure compliance with HIPAA and other healthcare regulations related to patient confidentiality and insurance authorizations.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
